Abstract:

Background: HIV/AIDS has been one of the major crises to affect Southern Africa,
particularly Botswana where prevalence rates have reached 37.3% of the adult population
(2003). Due to the difficult working environment and long periods of separation from their
partner, migrant workers have been highly susceptible to HIV infection and one of the
main vehicles through which the virus has been transmitted. While much research has
been carried out with mine workers, truck drivers, and other migrant groups, few studies
have investigated the risk factors of construction workers, which form one of the largest
employment groups in Botswana and Southern Africa. The purpose of this study was to
determine which factors contributed to construction workers’ engagement in sexual risk
behaviours, which have placed them at greater risk of HIV infection.
Methods: A cross-sectional analytic study design was used. Structured interviews were
carried out with individual migrant workers using a standardised questionnaire. 171 male
migrant workers were interviewed, involved in skilled, semi-skilled, and supervisory
professions. Interviews took place at three construction sites across Botswana, in the
capital city of Gaborone and the rural village of Serowe. Bivariate and multivariate
logistic regression analysis were carried out to determine which contributing factors were
significantly associated with respondents’ sexual risk behaviours.
Results: Unprotected sex was the most prevalent sexual risk behaviour, practised by
68.1% of construction workers. Significantly more workers engaged in unprotected sex
with their long-term partner (70.3%) than with their casual girlfriend (35.1%). The second
most common sexual risk behaviour was having multiple sexual partners. 57% of migrant
construction workers reported having an extra girlfriend in addition to their long-term
partner during the last five years. Transactional sex, involving the exchange of sex and
material support, was a key part of most workers’ (76.6%) sexual relations with casual
girlfriends. Commercial sex, though, was rarely reported and accounted for only 1.8% of
workers. Men having sex with men (MSM) was strongly denied by construction workers,
although 9.5% reported its occurrence in the workplace.
In the multivariate analysis, migration was one of the most significant factors associated
with respondents’ sexual risk behaviours. Compared to those who remained in one
location during the last year, workers who migrated between work locations were 3.01
times more likely to have had transactional sex (p=0.013) and 4.42 times more likely to
have had an extra girlfriend over the last five years (p=0.005). Workers who were
separated from their main partner for a month or more at a time were 3.74 times more
likely to have had an extra girlfriend in the last year (p=0.009) and 4.57 times more likely
to have had transactional sex in the last five years (p=0.001). Workers who stayed in the
construction on-site accommodation when away from home were 3.00 times (p=0.023)
more likely to have multiple partners compared to those who stayed in private
accommodation, where their partner had more opportunity to visit them.
A second major contributing factor was respondents’ gender attitudes, particularly the
perception that ‘one woman is not enough to sexually satisfy me as man’. Workers with
this attitude were 6.21 times more likely to have currently multiple partners (p<0.001),
9.05 times more likely to have had an extra girlfriend in the last five years (p=0.015), and
3.35 times likely to have had transactional sex (p=0.031). A number of socio-demographic
factors were significantly associated with sexual risk behaviours including respondents’
age, number of children, employment position, salary, workplace location, and education
level. It is important to note, however, that respondents’ alcohol consumption and level of
HIV/AIDS awareness did not significantly influence their sexual risk behaviours.
Conclusion: These findings indicate that labour migration plays a central role in
determining whether workers engage in sexual risk behaviours. Steps taken by employers
to: (i) increase the frequency with which workers can visit their partner, (ii) provide
facilities for long-term partners to visit the workplace, and (iii) reduce the frequency with
which workers are transferred between sites - could significantly reduce workers’
susceptibility to HIV infection. Alongside migration, though, gender attitudes played a
major role, pointing to the need for more education which focuses on gender attitudes and
behaviour change rather than solely HIV/AIDS awareness.